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Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States

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Abstract

Background

Recent trends on outcomes in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) suggest improvements in early survival. However, with the ever-changing landscape in management of CS, we sought to identify age-based trends in these outcomes and mechanical circulatory support (MCS) use among patients with both AMI and non-AMI associated shock.

Methods

We queried the 2005–2014 Nationwide Inpatient Sample databases to identify patients with a diagnosis of cardiogenic shock. Trends in the incidence of hospital-mortality, and use of MCS such as intra-aortic balloon pump (IABP), Impella/TandemHeart (IMP), and extra corporeal membrane oxygenation (ECMO) were analyzed within the overall population and among different age-categories (50 and under, 51–65, 66–80 and 81–99 years). We also made comparisons between patient groups admitted with CS complicating AMI and those with non-AMI associated CS.

Results

We studied 144,254 cases of CS, of which 55.4% cases were associated with an AMI. Between 2005 and 2014, an overall decline in IABP use (29.8–17.7%; ptrend < 0.01), and an uptrend in IMP use (0.1–2.6%; ptrend < 0.01), ECMO use (0.3–1.8%; ptrend < 0.01) and in-hospital mortality (44.1–52.5% AMI related, 49.6–53.5% non-AMI related; ptrend < 0.01) was seen. Patients aged 81–99 years had the lowest rate of MCS use (14.8%), whereas those aged 51–65 years had highest rate of MCS use (32.3%). Multivariable analysis revealed that patients aged 51-65 years (aOR 1.46, 95% CI 1.40–1.52; p<0.001), 66–80 years (aOR 2.51, 95% CI 2.39–2.63; p<0.01) and 81–99 years (aOR 5.04, 95% CI 4.78–5.32; p<0.01) had significantly higher hospital mortality compared to patients aged ≤ 50 years. Patients admitted with CS complicating AMI were older and had more comorbidities, but lower hospital mortality (45.0 vs. 48.2%; p < 0.001) when compared to non-AMI related CS. We also noted that the proportion of patients admitted with CS complicating AMI significantly decreased from 2005 to 2014 (65.3–45.6%; ptrend < 0.01) whereas those admitted without an associated AMI increased.

Conclusions

IABP use has declined whereas IMP and ECMO use has increased over time among CS admissions. Older age was associated with an incrementally higher independent risk for hospital mortality. Recent trends indicate an increase in both proportion of patients admitted with CS without associated AMI and in-hospital mortality across all CS admissions irrespective of AMI status.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Lehigh Valley Hospital Network, 1250S Cedar Crest Blvd, Suite 300, Allentown, PA, 18103, USA

    Mahek Shah, Brijesh Patel & Lohit Garg

  2. Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA

    Soumya Patnaik & Pradhum Ram

  3. Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Manyoo Agarwal

  4. Department of Cardiology, St. Luke’s University Health Network, Bethlehem, PA, USA

    Sahil Agrawal

  5. Department of Medicine, Mount Sinai St Luke’s-Roosevelt Hospital, New York, NY, USA

    Shilpkumar Arora

  6. Department of Medicine, Saint Peter’s University Hospital, New Brunswick, NJ, USA

    Nilay Patel

  7. Department of Cardiology, Hospital of University of Pennsylvania, Philadelphia, PA, USA

    Joyce Wald

  8. Department of Cardiology, Montefiore Medical Center, New York, NY, USA

    Ulrich P. Jorde

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  1. Mahek Shah
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Correspondence to Mahek Shah.

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Shah, M., Patnaik, S., Patel, B. et al. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol 107, 287–303 (2018). https://doi.org/10.1007/s00392-017-1182-2

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  • DOI: https://doi.org/10.1007/s00392-017-1182-2

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